- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews ... for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as required. +… more
- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization / appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors ... advisors and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with all insurance and regulatory… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The Manager , Denials Prevention & Appeals Operations is responsible for the direct oversight of daily operations of clinical denial ... position will work closely with the Denials Prevention & Appeals Administration Manager to guide the development...the Physician Advisors or attending physicians to support concurrent appeals . * Monitor and analyze utilization data… more
- Actalent (Sacramento, CA)
- …and Reviews. + Experience with prior authorization, pre-service and post-service review, appeals , utilization management, utilization review, and case ... Job Title: Appeals and Grievances Registered Nurse Job Description We...appropriate care. This position reports directly to the Nurse Manager and plays a key role in providing fair… more
- Elevance Health (Norfolk, VA)
- **Title: Grievance/ Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... for employment, unless an accommodation is granted as required by law._ The **Grievance/ Appeals Analyst I** is an entry level position in the Enterprise Grievance &… more
- Molina Healthcare (Yonkers, NY)
- …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. +… more
- Catholic Health (Buffalo, NY)
- …role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out and documenting ... the appeals process for denied claims denied due to reasons...payers) and internal stakeholders including, but not limited to, Utilization Review, Case Management, Clinical Documentation Integrity, Health Information… more
- Elevance Health (Richmond, VA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Medical Director-Dermatology Appeals ** **Location:** This role enables associates to work...and quality. + Work independently with oversight from immediate manager . + May be responsible for an entire clinical… more
- Elevance Health (New York, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Behavioral Health Medical Director-Psychiatrist Appeals ** **Location:** This role enables associates to work...Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical… more
- Elevance Health (Chicago, IL)
- ** Appeals Nurse Reviewer I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization, out of… more
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